Children's Dietary Recalls Research Articles

Effect of nutrition counselling with a digital job aid on child dietary diversity: Analysis of secondary outcomes from a cluster randomised controlled trial in rural Bangladesh.

Adequate dietary diversity among infants is often suboptimal in developing countries. We assessed the impact of nutrition counselling using a digital job aid on dietary diversity of children aged 6–23 months using data from a cluster randomised controlled trial in Bangladesh. The trial had five arms, each with 25 clusters. The four intervention arms provided counselling using a digital job aid and different prenatal and post‐natal combinations of lipid‐based supplements and the comparison arm with usual practice. We enrolled 1500 pregnant women and followed them until the children reached their second birthday. We developed a tablet‐based system for intervention delivery, data collection and project supervision. We combined the four intervention arms (n = 855), in which community health workers (CHWs) provided age‐appropriate complementary feeding counselling, to compare against the comparison arm (n = 403). We calculated the outcome indicators from the children's 24‐h dietary recalls. Overall, the intervention increased the mean dietary diversity score by 0.09 (95% confidence interval [CI]: 0.2–0.16) and odds of minimum dietary diversity by 18% (95% CI: 0.99–1.40). However, there was a significant interaction on the effect of the intervention on dietary diversity by age. The mean dietary diversity score was 0.24 (95% CI: 0.11–0.37) higher in the intervention than in the comparison arm at 9 months and 0.14 (95% CI: 0.01–27) at 12 months of age. The intervention effect was non‐significant at an older age. Overall, consumption of flesh food was 1.32 times higher in the intervention arm (odds ratio [OR] 1.32, 95% CI: 1.11–1.57) in 6–23 months of age. The intervention significantly improved child dietary diversity score in households with mild and moderate food insecurity by 0.27 (95% CI: 0.06–0.49) and 0.16 (0.05–27), respectively, but not with food‐secure and severely food‐insecure households. Although the study did not evaluate the impact of digital job aid alone, the findings indicate the utility of nutrition counselling by CHWs using a digital job aid to improve child feeding practices in broader programmes.

Parents' cooking skills confidence reduce children's consumption of ultra-processed foods

Ultra-processed foods are industrial formulations requiring little if any preparation before consumption. Their consumption is increasing in many countries and one of the possible determinants is the decrease in home cooking. As parents are key for family meals, we analysed the influence of parents' cooking skills confidence on children's consumption of ultra-processed foods at dinner. This is a cross-sectional study with 657 child-parent pairs from nine private schools in São Paulo, Brazil. Food consumption data were collected using two children's dinner dietary recalls while the Cooking Skills Index was used to collect parents' cooking skills, measuring their confidence in their own skills related to cooking ‘from scratch’, according to the Dietary Guidelines for the Brazilian Population. Food items were classified according to the NOVA classification system, considering the nature, extension and purpose of food processing. We used linear regression models to test associations between parents' cooking skills confidence and the contribution of ultra-processed foods to total energy intake at dinner, adjusting for socio-demographic variables. Parents' mean age was 38.3 and children's mean age was 7.8. These parents were mostly women, white, married, employed, with full secondary education and per capita household incomes up to ~ USD 320.00/month. They reached an average of 78.8 points (SD 14.8) in the Cooking Skills Index. Children's mean energy intake at dinner was 672.2 kcal (31.3% from ultra-processed foods). The increase in parents' cooking skills confidence was directly associated with decrease in consumption of ultra-processed foods (β = −0.17; p = 0.007), which remained after adjustment (β = −0.15; p = 0.026). These findings suggest that parents' cooking skills confidence potentially protect their children against ultra-processed foods, indicating the need for revaluing cooking to promote healthy eating.

Differences in Children's Dietary Recall Accuracy for Energy at School Meals by Social Desirability, Socioeconomic Status and Body Mass Index

Differences in Children's Dietary Recall Accuracy for Energy at School Meals by Social Desirability, Socioeconomic Status and Body Mass Index

The relationship of school absenteeism with body mass index, academic achievement, and socioeconomic status among fourth-grade children.

Data from a school-based study concerning fourth-grade children's dietary recall accuracy were linked with data from the South Carolina Department of Education (SCDE) through the South Carolina Budget and Control Board Office of Research and Statistics (ORS) to investigate the relationships of children's school absenteeism with body mass index (BMI), academic achievement, and socioeconomic status (SES). Data for all variables were available for 920 fourth-grade children during 2 school years (2005-2006, 2006-2007). Number of school days absent for each child and eligibility for free/reduced-price school meals (SES measure) were provided to ORS by SCDE. Children's weight and height were measured by research staff; age/sex-specific BMI percentile was calculated and grouped into categories. For academic achievement, Palmetto Achievement Challenge Tests scores were provided by the school district. The associations of absenteeism with BMI, academic achievement, SES, and school year were investigated with logistic binomial models using the modified sandwich variance estimator to adjust for multiple outcomes within schools. The relationships between absenteeism and each of BMI percentile category and SES were not significant (all coefficient p values > .118). The relationship between absenteeism and academic achievement was inversely significant (p value < .0001; coefficient = -.087). These results support the inverse relationship between absenteeism and academic achievement that was expected and has been found by other researchers. The lack of significant results concerning the relationships between absenteeism and both BMI and SES differs from earlier, limited research. More research to investigate these relationships is needed.

Relation of Children's Dietary Reporting Accuracy to Cognitive Ability

A validation study of children's dietary reporting provided an opportunity to investigate whether cognitive ability is a source of systematic error in dietary recalls. From the fall of 2004 through the spring of 2007, fourth-grade children (n = 374) in Columbia, South Carolina, were observed eating school meals and interviewed to obtain 24-hour dietary recalls; subsequently, measures of dietary reporting error were calculated. The common factor extracted from 4 subject-area achievement tests (scores on which were provided by the school district for 362 children) was used as a measure of cognitive ability. For the 325 children who reported school meals that met the criteria to be reports about school meals, as cognitive ability increased, dietary reporting error decreased; the relation between cognitive ability and dietary reporting performance was stronger among girls than among boys. The mean cognitive ability for 37 children who reported no meals that satisfied the criteria for being reports about school meals was significantly lower than that for the 325 children who reported meals that satisfied these criteria. These findings indicate that cognitive ability is a source of systematic error in children's dietary recalls. More generally, the quality of epidemiologic survey data may depend systematically on the cognitive ability of respondents.

Investigation of fourth‐grade children's dietary recall accuracy and their achievement test scores (ATS)

Each of 374 children (96% Black) was observed eating school breakfast and school lunch, and then interviewed to obtain a 24‐hour dietary recall that included the 2 observed meals. The school district provided ATS. Regression analysis showed that ATS were negatively correlated with omission rates (standardized regression coefficient [SRC] = −0.256; p &lt; 0.001) and intrusion rates (SRC = −0.118; p = 0.015), 2 measures of reporting error for food items, and total inaccuracy (SRC = −0.120; p = 0.019), a measure that combined reporting errors for food items and amounts, and positively correlated with correspondence rates (SRC = 0.234; p &lt; 0.001), a measure of reporting accuracy for energy. Effect sizes were small to medium for intrusion rate and total inaccuracy, and medium to large for omission rate and correspondence rate. Knowing that children's ATS are related to their dietary recall accuracy could be helpful for future school‐based nutrition studies which use dietary recalls provided by children. As achievement testing is routine in school districts, researchers could obtain ATS (for individual children) from districts and consider them when using dietary recalls to assess, for example, the relative validity of food frequency questionnaires or the effectiveness of school‐based interventions to improve children's dietary intake. Funded by R01HL074358.

Fourth-Grade Children's Dietary Recall Accuracy Is Influenced by Retention Interval (Target Period and Interview Time)

BackgroundFor a 24-hour dietary recall, two possible target periods are the prior 24 hours (24 hours immediately preceding the interview time) and previous day (midnight to midnight of the day before the interview), and three possible interview times are morning, afternoon, and evening. Target period and interview time determine the retention interval (elapsed time between to-be-reported meals and the interview), which, along with intervening meals, can influence reporting accuracy. ObjectiveThe effects of target period and interview time on children's accuracy for reporting school meals during 24-hour dietary recalls were investigated. Design and subjects/settingDuring the 2004-2005, 2005-2006, and 2006-2007 school years in Columbia, SC, each of 374 randomly selected fourth-grade children (96% African American) was observed eating two consecutive school meals (breakfast and lunch) and interviewed to obtain a 24-hour dietary recall using one of six conditions defined by crossing two target periods with three interview times. Each condition had 62 or 64 children (half boys). Main outcome measuresAccuracy for reporting school meals was quantified by calculating rates for omissions (food items observed eaten but unreported) and intrusions (food items reported eaten but unobserved); a measure of total inaccuracy combined errors for reporting food items and amounts. Statistical analyses performedFor each accuracy measure, analysis of variance was conducted with target period, interview time, their interaction, sex, interviewer, and school year in the model. ResultsThere was a target-period effect and a target-period by interview-time interaction on omission rates, intrusion rates, and total inaccuracy (six P values <0.004). For prior-24-hour recalls compared to previous-day recalls, and for prior-24-hour recalls in the afternoon and evening compared to previous-day recalls in the afternoon and evening, omission rates were better by one third, intrusion rates were better by one half, and total inaccuracy was better by one third. ConclusionsTo enhance children's dietary recall accuracy, target periods and interview times that minimize the retention interval should be chosen.

Children's body mass index percentile (BMI%), social desirability score (SDS) and dietary recall accuracy for energy

We examined whether 4th‐grade children's dietary recall accuracy for energy varied by BMI% and SDS. Each of 374 children (96% Black) was observed eating 2 school meals (breakfast, lunch) and interviewed to obtain a 24‐hour recall that included the 2 observed school meals. At the end of the interview (after the recall), children responded to 14 social desirability questions. We weighed and measured children, and calculated BMI%. We quantified accuracy of recalling energy intake at school meals by calculating conventional report rates (total reported energy/total observed energy) and the 2 components of report rate ‐ correspondence rate (total correctly reported energy/total observed energy) and inflation ratio (total intruded energy/total observed energy). For each measure, ANOVA was conducted with sex, BMI% x sex, SDS x sex, and BMI% x SDS x sex in the model; results were adjusted for other covariables. Report rates increased (indicating less underreporting) as BMI% and SDS decreased (2 p values = 0.001). Correspondence rates increased (indicating better accuracy) as SDS decreased (p = 0.013). Inflation ratios decreased (indicating better accuracy) as BMI% increased (p &lt; 0.001). Report rates alone do not provide a complete picture of the relationship of children's dietary recall accuracy for energy with BMI% and SDS; BMI% and SDS appear to be related to separate aspects of recall accuracy. Funded by R01 HL074358.

Assessing agreement among observers of fourth‐grade children's dietary intake at school meals

For a dietary‐reporting validation study conducted over 3 school years, researchers unobtrusively observed the food items and per‐item amounts eaten by children during certain school meals. To investigate children's dietary recall accuracy, observed information was compared to reported information from a subsequent interview with the child. Amounts observed eaten were recorded in servings of standard school‐meal portions as none = 0, taste = 0.1, little bit = 0.25, half = 0.5, most = 0.75, all = 1.0, or the number of servings if &gt;1. Two researchers observed the same child at the same meal and recorded intake (281 meals). We compared pairs of observations to assess interobserver reliability (IOR) among 6 observers. To summarize observer agreement, we investigated statistics for different levels of information. Pearson's correlation was 93% for servings per food item and 96% for servings per meal. The table shows percent agreement and Cohen's Kappa. Beverages served in opaque containers accounted for 94 of 257 items for which observers recorded amounts that differed by =0.25 servings. This led to using a tolerance of 0.25 servings for matches. All measurements indicated good levels of IOR. Funded by R01 HL074358.

Twenty-four hour dietary recalls by fourth-grade children were not influenced by observations of school meals

Objective To investigate whether school-meal observations influenced children's 24-hour dietary recalls. Study Design and Setting Over three school years, 555 randomly selected fourth-grade children were interviewed to obtain a 24-hour dietary recall; before being interviewed, 374 children were observed eating two school meals (breakfast, lunch), and 181 children were not observed. Within observation-status groups (observed, unobserved), children were randomized within sex to one of six combinations from two target periods (prior 24 hours, previous day) crossed with three interview times (morning, afternoon, evening). Results For each of the five variables (interview length, meals/snacks, meal components, items, kilocalories), naïve and adjusted equivalence tests rejected that observation-status groups were different, indicating that school-meal observations did not influence children's 24-hour dietary recalls. There was a target-period effect on length ( P < 0.0001) (longer for prior-24-hour recalls), a school year effect on length ( P = 0.0002) (longer for third year), and a target period–interview time interaction on items ( P = 0.0110) and kilocalories ( P = 0.0047) (both smaller for previous-day recalls in the afternoon than prior-24-hour recalls in the afternoon and previous-day recalls in the evening), indicating that variables were sufficiently sensitive and psychometrically reliable. Conclusion Conclusions about 24-hour dietary recalls by fourth-grade children observed eating school meals in validation studies are generalizable to 24-hour dietary recalls by comparable but unobserved children in nonvalidation studies.

Cognitive processes in children's dietary recalls: insight from methodological studies

This article summarizes 12 dietary-reporting methodological studies with children (six validation studies, one non-validation study, five secondary analyses studies of data from one or more of the six validation studies), identifies research gaps and provides recommendations for (a) improving children's recall accuracy and (b) details to specify in publications of studies that utilize children's dietary recalls. Randomly selected children (aged 9-10 years) were observed eating school breakfast and school lunch, and interviewed to obtain dietary recalls. Children's recall accuracy improved slightly between the first and third recalls, but an individual child's accuracy was inconsistent from one interview to the next. Although accuracy was poor overall, it was better for boys with reverse-order (evening-to-morning) prompts and for girls with forward-order (morning-to-evening) prompts. Children recalled breakfast intake less accurately than lunch intake. Children's accuracy did not depend on whether recalls were obtained in person or by telephone, but was better for recalls obtained with an open format than a meal format. Retention interval was crucial as children's accuracy was better for prior-24-h recalls (about the 24 h immediately preceding the interview) than for previous-day recalls (about midnight to midnight of the day before the interview). Observations of school meals did not affect children's recalls. Children's recall accuracy was related to their age/sex body mass index percentile. Conventional report rates (which disregard accuracy for items and amounts) overestimated accuracy for energy and macronutrients, and masked complexities of recall error. Research concerning errors in children's dietary recalls provides insight for improving children's recall accuracy.

Sources of Intrusions in Children's Dietary Recalls from a Validation Study of Order Prompts

Validation-study data and foodservice production records were analyzed to test hypotheses concerning sources of intrusions (reports of uneaten items) in the school-meal parts of children's dietary recalls. Each child was observed eating school meals on two days, and interviewed the morning after each observation day; one interview used forward-order (morning-to-evening) and one used reverse-order (evening-to-morning) prompts. Lunch intrusions were likelier to have been available in the foodservice environment at lunch as day before the interview came closer, and on days before than after the interview. Temporal dating errors are contributing sources of intrusions in the school-lunch parts of children's recalls.

Intrusions in Children's Dietary Recalls: The Roles of BMI, Sex, Race, Interview Protocol, and Social Desirability

Dietary-reporting validation study data and school foodservice production records were used to examine intrusions (reports of uneaten items) in school meals in 24-h recalls. Fourth-grade children [20 low-BMI (> or = 5th and < 50th percentiles); 20 high-BMI (> or = 85th percentile); 50% boys; 75% black] were each observed eating two school meals (breakfast, lunch) and interviewed about the prior 24h that evening (24E) or the previous day the next morning (PDM). Social desirability was assessed. Intrusions were classified as stretches (on meal tray), internal confabulations (in school foodservice environment but not on meal tray), and external confabulations (not in school foodservice environment). For breakfast, reported items were less likely to be intrusions for black than white children, and for low-BMI boys than the other BMI-x-sex groups, and to be external confabulations for high-BMI girls than high-BMI boys. For lunch, reported items and intrusions were more likely to be stretches for 24E than PDM interviews. As social desirability increased, fewer items were reported for breakfast, and reported items and intrusions were more likely to be internal confabulations for lunch. For breakfast, compared to low-BMI girls, as social desirability increased, intruded amounts were larger for high-BMI boys and smaller for high-BMI girls. For lunch, intruded amounts were smaller for high-BMI girls than the other BMI-x-sex groups. Amounts reported were smaller for stretches than internal confabulations and external confabulations for breakfast, and external confabulations for lunch. To better understand intrusions, dietary-reporting validation studies are needed with larger samples by BMI-group, sex, and race.

Insight into the Origins of Intrusions (Reports of Uneaten Food Items) in Children's Dietary Recalls, Based on Data from a Validation Study of Reporting Accuracy over Multiple Recalls and School Foodservice Production Records

Background Intrusions in dietary recalls may originate in confusion of episodic memories manifested as temporal dating errors. Objective Data from a validation study (concerning reporting accuracy over multiple recalls) and school foodservice production records were used to investigate origins of intrusions in school meals in children's 24-hour recalls. Design/subjects/setting During the 1999-2000 school year, 104 fourth-grade children were observed eating school meals on 1 to 3 nonconsecutive days separated by ≥25 days, and interviewed about the previous day's intake in the morning on the day after each observation day. Statistical analyses performed For breakfast and lunch separately, logistic regression was used to investigate the effect of time (ie, days) before the interview day on the probability that intrusions referred to items available in the school foodservice environment. Exploratory analyses were conducted for breakfast options observed and/or reported eaten. Results For interviews in which reported meals met criteria to be considered school meals and that contained intrusions, of 634 and 699 items reported eaten at breakfast and lunch, respectively, 394 and 331 were intrusions. Availability in the school foodservice environment of items referred to by intrusions in reports of lunch, but not breakfast, decreased as days increased before the interview day ( P=0.031 and P=0.285, respectively). Concerning breakfast, children observed eating a cold option (ie, ready-to-eat cereal, milk, juice, crackers [graham or animal]) almost always reported a cold option, whereas children observed eating a hot option (ie, non–ready-to-eat cereal entrée [eg, sausage biscuit], milk, and fruit or juice) reported a cold option in approximately 50% of interviews. Conclusions In children's 24-hour recalls, confusion of episodic memories contributes to intrusions in school lunch, and generic dietary information (eg, cold option items available daily) or confusion of episodic memories may contribute to intrusions in school breakfast. Understanding the origins of intrusions may help in developing interview methods to decrease the occurrence of intrusions.

P65: Data from a Validation Study of Reporting Accuracy over Multiple Recalls, and School Foodservice Production Records Provide Insight into the Origins of Intrusions in Children's Dietary Recalls

Intrusions (reports of uneaten items) in school meals in children's 24-hour recalls may originate in confusion of episodic memories manifested as temporal dating errors. This was investigated using validation-study data and school foodservice production records.

P66: Origins of Intrusions in Children's Dietary Recalls: Data from a Validation Study Concerning Target Period and Interview Time, and Information from School Foodservice Production Records

P66: Origins of Intrusions in Children's Dietary Recalls: Data from a Validation Study Concerning Target Period and Interview Time, and Information from School Foodservice Production Records

Target period, interview time, and fourth‐grade children's dietary recall accuracy

Target period, interview time, and fourth‐grade children's dietary recall accuracy

Children's Dietary Recalls from Three Validation Studies: Types of Intrusion Vary with Retention Interval.

Using previously collected data of fourth-grade children observed eating school meals and then interviewed, we categorized intrusions (food items reported but not observed eaten) as stretches (on the child's tray) or confabulations (not on the child's tray). We investigated intrusions, confabulations, and stretches, and the role of liking, at different retention intervals (morning interviews about the previous day's intake; evening interviews about that day's intake) and under different reporting-order prompts (forward; reverse). As retention interval between consumption and report increased, the likelihood 1) increased that reported items were intrusions, that reported items were confabulations, and that intrusions were confabulations; and 2) was constant that reported items were stretches. Results concerning reporting-order prompts were inconclusive. Liking ratings were higher for matches (reports of items observed eaten) than stretches, for confabulations than stretches, and for matches than omissions (unreported items observed eaten), but did not vary by retention interval or reporting-order prompts.

Recency affects reporting accuracy of children's dietary recalls.

This study evaluated the effect of recency on accuracy of fourth-graders' dietary reports. Each of 60 randomly selected children was observed eating school meals (breakfast, lunch) and interviewed to obtain a 24-hour dietary recall using one of six conditions generated by crossing two target periods (previous day, prior 24 hours) with three interview times (morning, afternoon, evening), with 10 children (5 males) per condition. Accuracy of the school meal portions of each recall was assessed by comparing reports to observations. Rates for omissions (items observed but not reported) and intrusions (items reported but not observed) were calculated to determine accuracy for reporting items. A measure of total inaccuracy combined errors for reporting items and amounts. Using the prior 24 hours as the target period yielded better performance than did using the previous day: Omission rates were lower by about one-third, intrusion rates by about one-half, and total inaccuracy by about one-third (all p's<0.01). A marginally significant interaction of target period by interview time was found for omission rate (p=0.08), but not for intrusion rate (p=0.15) or for total inaccuracy (p=0.47). This provides evidence that recency influences children's recall accuracy and demonstrates the importance of an awareness of principles of memory when designing what are essentially memory tests for epidemiologic studies.

Interview format influences the accuracy of children's dietary recalls validated with observations

This report describes a comparison of the accuracy of children's dietary recalls obtained using either open or meal format interviews. Fourth-graders were randomly selected, observed eating school meals (breakfast, lunch), and interviewed that evening regarding that day's intake with children randomly assigned to open ( n = 12) or meal ( n = 11) format interviews. The weighted numbers of items observed eaten did not differ by format, but greater weighted numbers of items were reported eaten with meal format interviews than with open format interviews. Reporting performance was more accurate with open than with meal format interviews: Although the omission rates did not differ significantly between the formats, higher intrusion rates and total inaccuracy were found in meal format interviews than in open format interviews. Interview format influences children's dietary reporting accuracy; in particular, providing meal cues elevates false reports. These analyses exemplify the importance of treating omissions and intrusions separately when examining reporting performance.